不同剂量顺式阿曲库铵的残余肌松作用

The Effect of the Residual Neuromuscular Blockade Caused by the Different Dose of Cisatracurium

目的观察不同剂量顺式阿曲库铵的残余肌松作用。方法择期行腰椎管狭窄或胸腰椎体骨折手术患者80例,美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级,年龄18～70岁,随机分为顺式阿曲库铵静脉持续输注组（A）,静脉间断给药组（B）。麻醉诱导后,A1组持续输注顺式阿曲库铵0.75μg·（kg·min）^-1,A2组1.5μg·（kg·min）^-1,B1组间断给药0.05 mg·（kg·h）^-1,B2组0.1 mg·（kg·h）^-1,每组各20例。手术结束前20min停用所有药物。使用闭环肌松注射系统（CLMRIS-I）进行肌松效应监测,记录肌松药使用总量、第一次睁眼时间、四个成串刺激比值（Train-of-Four ratio,TOFr）达25%、50%、75%、90%的时间、拔管时间、患者抬头5s的时间及患者麻醉前后潮气量、呼吸频率等。结果拔管时四组患者收缩压、舒张压、呼吸频率及氧饱和度与术前比较差异均无统计学意义（P〉0.05）,而拔管时心率较术前明显增快（P〈0.05）,A2、B1、B2组患者潮气量高于术前（P〈0.05）;同种给药方式下,顺式阿曲库铵高剂量组患者TOFr恢复至25%、50%、75%、90%时间、肌力达Ⅳ～Ⅴ级和能够持续抬头5s时间长于低剂量组（P〈0.05）,而拔管时间及第一次睁眼时间两组间差异无统计学意义（P〉0.05）。相同剂量下,持续输注给药较间断单次给药TOFr恢复至25%、50%、75%时间延长（P〈0.05）,而TOFr恢复至90%、拔管时间、第一次睁眼时间、肌力达Ⅳ-Ⅴ级和能够持续抬头5s时间两组间差异无统计学意义（P〉0.05）。结论不同剂量顺式阿曲库铵的术后残余肌松作用不同,高剂量可延长患者术后肌肉功能恢复时间。顺式阿曲库铵持续输注与间断给药两种方式对残余肌松作用均无明显影响。

Objective To observe the effect of the residual neuromuscular blockade caused by the different dose of cisatracurium.Methods 80 ASAⅠorⅡpatients aged from 18 to 70,undergoing selective spinal surgery with general anesthesia,were equally randomized into four groups（ n = 20）.In group A1,patients received cisatracurium by continuous infusion with 0.75 μg·kg-1·min^-1and 1.5 μg· kg^-1·min^-1in group A2,group B1 by intermittent bolus injection with 0.05 mg·（ kg·h）-^11and group B2 with 0.1 mg·（ kg· h）^-1as well.After the induction,design the total dose of group A1 and B1 are the same,both of group A2 and B2,responses of adductor pollicis muscle to train-of-four（ TOF） stimulation were monitored.Stop all the drugs 20 minutes before the end of the surgery and recorded the cisatracurium consumption and TOF recovered to 25%,50%,75%,90%,extubation time,continue to look up 5 s,tidal volume and respiratory rate both before and after anesthesia.Results SBP,DBP,breathing rate and oxygen saturation at extubation in four groups of patients showed no statistically significant difference compared with those at preoperative（ P〈0.05）.The heart rate was significantly faster in four groups of patients and tidal volume tube drawing in three groups（ A2,B1,B2） of patients at extubation was significantly higher than those at preoperative（ P〈0.05）.In the same ways of giving cisatracurium,patients in the high-dosage groups got a longer time of TOFr recovery to 25%,50%,75% and 90%,respectively（ P〈0.05） than patients in the low dose group did（ P〈0.05）,and the same results as the clinical indications of monitoring muscle relaxant residual effect,muscle force back to Ⅳ-Ⅴ level,continue to look up 5s,while there was no statistical significant difference comparison in extubation time and the eyes opening time（ P〈0.05）.And at the same doses,patients in the continuous infusion group got a longer time of TOFr recovery to 25%,50% and 75%,respectively（ P〈0.05） compared with patients in the intermittent bolus injection group.The time of TOFr recovery to 90% and the clinical indications of monitoring muscle relaxant residual effect,（ extubation time,continue to look up 5 s,etc.） had no obvious difference（ P〈0.05） between two groups.Conclusion The dose of cisatracurium has influence on the residual effect of muscle relaxant.High dose may prolong the muscle recovery time.